NAME ___________________________________
AGE (if under 18) ____ DATE__________
STREET ADDRESS ______________________________________________________
CITY_____________________
STATE _______
ZIP ___________
DAY TELEPHONE _______________
EVENING TELEPHONE _______________
CELL TELEPHONE________________________
E-MAIL ADDRESS ___________________________________________________
CLASS/COMBO TITLE _____________________________________
TUITION __________
CLASS/COMBO TITLE _____________________________________
TUITION __________
________________I have read the PAYMENT AND REFUND POLICIES
and agree to them.
Signature of Student or Parent-Guardian
_____ I am registering 7 days or more in advance for 10% off the cost of
the class.
_____ I am registering for TWO or MORE classes: 25%
off additional classes of equal or lesser value.
METHOD OF PAYMENT: Paid in full
_____ $50.00
deposit _____
Personal check # _______ Money order # ________________ Amount
$__________
**Credit Card: Visa # ___________________________________
Master Card # ___________________________________
Discover #_______________________________________
**Charge the above Credit Card : $
_____________
Name on credit card ___________________________________
Expiration __________
Signature of card owner ___________________________________________________
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Mail To:
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N.J. School of Dramatic Arts
593 Bloomfield Avenue
Bloomfield, NJ 07003
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